Snoring and Sleep Apnea

Snoring and Sleep Apnea

People who snore loudly are often the target of bad jokes and middle of the night elbow thrusts; but snoring is no laughing matter. While loud disruptive snoring is at best a social problem that may strain relationships, for many men, women and even children, loud habitual snoring may signal a potentially life threatening disorder: obstructive sleep apnea, or OSA.

Snoring Is Not Necessarily Sleep Apnea

It is important to distinguish between snoring and OSA. Many people snore. It's estimated that approximately 30% to 50% of the US population snore at one time or another, some significantly. Everyone has heard stories of men and women whose snoring can be heard rooms away from where they are sleeping.

Snoring of this magnitude can cause several problems, including marital discord, sleep disturbances and waking episodes sometimes caused by one's own snoring. But, snoring does not always equal OSA; sometimes it is only a social inconvenience. Still, even a social inconvenience can require treatment, and there are several options available to chronic snorers.

Some non-medical treatments that may alleviate snoring include:

Weight loss — as little as 10 pounds may be enough to make a difference.

Change of sleeping position — Because you tend to snore more when sleeping on your back, sleeping on your side may be helpful.

Avoid alcohol, caffeine and heavy meals — especially within two hours of bedtime.

Avoid sedatives — which can relax your throat muscles and increase the tendency for airway obstruction related to snoring.

Your doctor has other treatment options, including the following:

Radio Frequency (RF) of the Soft Palate uses radio waves to shrink the tissue in the throat or tongue, thereby increasing the space in the throat and making airway obstruction less likely. Over the course of several treatments the inner tissue shrinks while the outer tissue remains unharmed. Several treatments may be required, but the long-term success of this procedure has not as yet been determined.

Laser-Assisted Uvuloplasty (LAUP) is a surgical procedure that removes the uvula and surrounding tissue to open the airway behind the palate. This procedure is generally used to relieve snoring and can be performed in the Oral and Maxillofacial Surgeon's office with local or general anesthesia.

Identifying and Treating OSA

Unlike simple snoring, obstructive sleep apnea is a potentially life-threatening condition that requires medical attention. The risks of undiagnosed OSA include heart attack, stroke, irregular heartbeat, high blood pressure, heart disease and decreased libido. In addition, OSA causes daytime drowsiness that can result in accidents, lost productivity and interpersonal relationship problems. The symptoms may be mild, moderate or severe.

Sleep apnea is fairly common. One in five adults has at least mild sleep apnea and one in 15 adults has at least moderate sleep apnea. OSA also affects 1% to 3% of children. During sleep, the upper airway can be obstructed by excess tissue, large tonsils and/or a large tongue. Also contributing to the problem may be the airway muscles, which relax and collapse during sleep, nasal passages, and the position of the jaw.

The cessation of breathing, or "apnea," brought about by these factors initiates impulses from the brain to awaken the person just enough to restart the breathing process.This cycle repeats itself many times during the night and may result in sleep deprivation and a number of health-related problems. Sleep apnea is generally defined as the presence of more than 30 apneas during a seven hour sleep. In severe cases, periods of not breathing may last for as long as 60 to 90 seconds and may recur up to 500 times a night.

Symptoms of Sleep Apnea

Those who have OSA are often unaware of their condition and think they sleep well. The symptoms that usually cause these individuals to seek help are daytime drowsiness or complaints of snoring and breathing cessations observed by a bed partner. Other symptoms may include:

·         Snoring with pauses in breathing (apnea)

·         Excessive daytime drowsiness

·         Gasping or choking during sleep

·         Restless sleep

·         Problem with mental function

·         Poor judgment/can't focus

·         Memory loss

·         Quick to anger

·         High blood pressure

·         Nighttime chest pain

·         Depression

·         Problem with excess weight

·         Large neck (>17" around in men, >16" around in women)

·         Airway crowding

·         Morning headaches

·         Reduced libido

·         Frequent trips to the bathroom at night

Diagnosing Sleep Disorders

If you exhibit several OSA symptoms, it's important you visit your Oral and Maxillofacial Surgeon for a complete examination and an accurate diagnosis.

At your first visit, your doctor will take a medical history and perform a head and neck examination looking for problems that might contribute to sleep-related breathing problems. An interview with your bed partner or other household members about your sleeping and waking behavior may be in order. If the doctor suspects a sleep disorder, you will be referred to a sleep clinic, which will monitor your nighttime sleep patterns through a special test called polysomnography.

Polysomnography will require you to sleep at the clinic overnight while a video camera monitors your sleep pattern and gathers data about the number and length of each breathing cessation or other problems that disturb your sleep. Often a "split night" study is done during which a C-PAP (continuous positive airway pressure) device is used. During polysomnography, every effort is made to limit disturbances to your sleep.

Treating Sleep Apnea

Obstructive sleep apnea can be effectively treated. Depending on whether your OSA is mild, moderate or severe, your doctor will select the treatment that is best for you.

Behavior Modification - If you are diagnosed with mild sleep apnea, your doctor may suggest you employ the non-medical treatments recommended to reduce snoring: weight loss; avoiding alcohol, caffeine and heavy meals within two hours of bedtime; no sedatives; and a change of sleeping positions. In mild cases, these practical interventions may improve or even cure snoring and sleep apnea.

Oral Appliances - If you have mild to moderate sleep apnea, or are unable to use C-PAP, recent studies have shown that an oral appliance can be an effective first-line therapy. The oral appliance is a molded device that is placed in the mouth at night to hold the lower jaw and bring the tongue forward. By bringing the jaw forward, the appliance elevates the soft palate or retains the tongue to keep it from falling back in the airway and blocking breathing. Although not as effective as the continuous positive airway pressure (C-PAP) systems, oral appliances are indicated for use in patients with mild to moderate OSA who prefer oral appliances, who do not respond to C-PAP, are not appropriate candidates for C-PAP, or who fail treatment attempts with C-PAP or behavioral changes.

Patients using an oral appliance should have regular follow-up office visits with their Oral and Maxillofacial Surgeon to monitor compliance, to ensure the appliance is functioning correctly and to make sure their symptoms are not worsening.

C-PAP (Continuous Positive Airway Pressure) and Bi-PAP (Bi-Level) - A C-PAP device is an effective treatment for patients with moderate OSA and the first-line treatment for those diagnosed with severe sleep apnea.Through a specially fitted mask that fits over the patient's nose, the C-PAP's constant, prescribed flow of pressured air prevents the airway or throat from collapsing. In some cases a Bi-PAP device, which blows air at two different pressures, may be used.

While C-PAP and Bi-PAP devices keep the throat open and prevent snoring and interruptions in breathing, they only treat your condition and do not cure it. If you stop using the C-PAP or Bi-PAP, your symptoms will return. Although C-PAP and Bi-PAP are often the first treatments of choice, they may be difficult for some patients to accept and use. If you find you are unable to use these devices, do not discontinue their use without talking to your doctor.Your Oral and Maxillofacial Surgeon can suggest other effective treatments.

Surgery for Sleep Apnea

Surgical intervention may be a viable alternative for some OSA patients; however, it is important to keep in mind that no surgical procedure is universally successful. Every patient has a different shaped nose and throat, so before surgery is considered your Oral and Maxillofacial Surgeon will measure the airway at several points and check for any abnormal flow of air from the nose to lungs. Be assured, your doctor has considerable experience and the necessary training and skill to perform the following surgical procedures:

Uvulopalatopharyngoplasty (UPPP) - If the airway collapses at the soft palate, a UPPP may be helpful. UPPP is usually performed on patients who are unable to tolerate the C-PAP. The UPPP procedure shortens and stiffens the soft palate by partially removing the uvula and reducing the edge of the soft palate.

Hyoid Suspension - If collapse occurs at the tongue base, a hyoid suspension may be indicated. The hyoid bone is a U-shaped bone in the neck located above the level of the thyroid cartilage (Adam's apple) that has attachments to the muscles of the tongue as well as other muscles and soft tissues around the throat.The procedure secures the hyoid bone to the thyroid cartilage and helps to stabilize this region of the airway.

Genioglossus Advancement (GGA) - GGA was developed specifically to treat obstructive sleep apnea, and is designed to open the upper breathing passage. The procedure tightens the front tongue tendon; thereby, reducing the degree of tongue displacement into the throat. This operation is often performed in tandem with at least one other procedure such as the UPPP or hyoid suspension.

Maxillomandibular Advancement (MMA) - MMA is a procedure that surgically moves the upper and lower jaws forward. As the bones are surgically advanced, the soft tissues of the tongue and palate are also moved forward, again opening the upper airway. For some individuals, the MMA is the only technique that can create the necessary air passageway to resolve their OSA condition.

Talk With Your Doctor

Sleep apnea is a serious condition and individuals with OSA may not be aware they have a problem. If someone close to you has spoken of your loud snoring and has noticed that you often wake up abruptly, gasping for air, you should consult your Oral and Maxillofacial Surgeon.

Our Gums, Ourselves

Hormonal changes make women prone to periodontal disease, researcher says

It’s not news that the female sex hormones affect more than a woman’s reproductive system. Scientists studying the seemingly unlikely relationship between reproductive health and oral health have discovered that pregnant women with periodontal disease are at increased risk for having premature and/or low birthweight babies. That’s why periodontal care is now a routine part of prenatal care.

But the relationship between periodontal health and female reproductive hormones goes beyond pregnancy. Fluctuating hormone levels over the course of a woman’s life can lead to changes in her oral health. In a review published last year in the Spanish language journal Perínatologia y Reproducción Humana, Eduardo Marcuschamer, DG09, an instructor in periodontology at the School of Dental Medicine, describes how the hormones estrogen and progesterone put women at increased risk for gingivitis, even if they are not pregnant.

Gingivitis, which affects adults of both sexes, is caused by an increase in pathogenic—or disease-causing—bacteria in the mouth. Some 700 different species of bacteria can live in the mouth, usually harmoniously. But poor oral hygiene, tobacco use or a depressed immune system can throw the mouth’s delicate ecosystem out of balance, favoring the bad guys. The resulting bacterial infection leads to the swollen, red gums that are the hallmark of gingivitis. Periodontal disease, which causes tooth loss, may follow.

“Hormones travel in the bloodstream and act on every single tissue,” says Marcuschamer, who wrote his review article when he was a resident at Tufts following a stint as a dental resident at the Instituto Nacional de Perinatología in Mexico, which specializes in high-risk pregnancies. And estrogen and progesterone are especially likely to accumulate in the gum tissues, which are physiologically similar to the mucosal tissues of the reproductive system.

It all starts in puberty, when a dramatic surge of the two female sex hormones can trigger gingivitis in young girls. Scientists suspect that progesterone increases the permeability of blood vessels in the gums, making them more susceptible to swelling. Luckily, this adolescent gingivitis is short-lived and not associated with the increase in oral bacteria that generally accompanies adult gum disease. Good oral hygiene before, during and after puberty can prevent this temporary discomfort from becoming more severe, says Marcuschamer.

The monthly ebb and flow of the female sex hormones continue to affect the oral tissue for as long as a woman menstruates. Researchers have found that cellular fluids related to gingivitis increase in the gum tissue during ovulation, although most women never notice this. Again, the condition is usually minor and temporary, but women with pre-existing gingivitis or periodontal disease may suffer exaggerated symptoms. Additionally, ovulating women may be at increased risk for other oral lesions, including herpes and thrush.

Prevention Is the Key

But it’s during pregnancy—when estrogen and progesterone levels skyrocket 10 to 30 times higher than before conception—when women are most at risk for gingivitis and periodontal disease. And because birth control pills work by tricking the body into thinking it’s already pregnant by increasing levels of progesterone and estrogen in the blood, women taking oral contraceptives are at risk for gum disease, too.

“Pregnancy is a time of life when the hormonal changes are most notorious,” says Marcuschamer, who is using the findings from his review paper to develop a lecture for Tufts periodontal students.

Gingivitis most often appears during the second or third month of pregnancy, peaks in the eighth month, and then decreases in the ninth month as a woman’s hormone levels begin to subside in preparation for childbirth.

More alarming, a small number of pregnant women develop “pregnancy tumors” called pyogenic granuloma. These small red or purplish-blue masses often occur along the scalloped edge of the gum line; they’re painless, but prone to bleeding. Unlike gingivitis, pregnancy tumors usually shrink or disappear completely after childbirth.

Older women are also susceptible to oral health problems. During menopause, when levels of estrogen and progesterone decline, the mucosal tissues throughout the body—including vaginal and oral tissues—can become thin, dry and prone to bleeding. Dry mouth can accelerate tooth decay and cause discomfort while eating or speaking.

Throughout a woman’s life, says Marcuschamer, an ounce of prevention is worth a pound of cure. Good oral hygiene, regular check-ups and treatment when necessary will keep gingivitis at bay and prevent the onset of periodontal disease. Perhaps more important, Marcuschamer recommends more coordination among a woman’s physician, general dentist and periodontist. “We shouldn’t wait until a woman is pregnant to start worrying about gingivitis,” says Marcuschamer. “We should work on prevention throughout her lifetime.”

Our staff is eager to help you achieve a healthy smile. “Let’s talk about your smile!” Please call our office at (305) 534-2002 to schedule an appointment or visit our website at http://www.4everteeth.com.

4everteeth Dental Center -Miami Beach

Dr. Arnold Rothman

http://www.4everteeth.com.

(305) 534-2002

939 Arthur Godfrey Rd.

Miami Beach, Fl 33140

Staying on the Path of Health

Maintaining good health has a wide range of implications dependent on a person’s motivation, curiosity, dependability and responsibility.  Yes, I know this is a broad statement. But I must confess in my experience people with these personality traits seem to be more respectful of their health care experts efforts.  It is noticeable that they follow instructions regarding recommended care, and it seems obvious that this character trait is evident in most other areas of their lives.  In other words, they have an awareness that allows them to be trustworthy, loyal, helpful friendly, courteous, kind, obedient (when it was in their interest), cheerful, brave, clean and reverent!  Experience has led me to believe healthy people are equipped to do better for themselves and others in all aspects of life.  Good health reflects “wellness.” Promoting good health is worthwhile!

In other words, we are responsible for our health. It’s a job we cannot delegate with any surety.  However, let me suggest, it is wise to have in place a team of healthcare providers that are trustworthy because the truth is: we are subject to illness.  A primary physician should function as a “health advisor/mentor”.  Knowing many patients use technology, like the internet as their principle source of information worries me.  Not that there isn’t good information available, it’s just that not depending on the  many years of education and experience of their own carefully chosen medical advocates in conjunction with seeking outside sources could lead to serious consequences. The very worst cases are those who do not understand all the nuances and implications “out there”, which often leads to neglect or worse.

Sadly, some patients selectively ignore parts of their lives and decide to improve their over-all health by running, yoga (to name examples) but continue to smoke and drink.  On the other hand, they are those who are knowledgeable about nutrition but never follow through with any sort of medical checkup. 

The word is: good health starts with genetics but is reliant upon prevention, which requires constant vigilance.  Considering the absorbent cost of getting back to health is much greater than the cost of maintenance, not losing sight of the overall requirements in the first place seems to me goods advice.  I have quite a few patients in their 90s with a full complement of teeth and not one case was restoration free.  It is safe to say the common denominator of these smiling senior citizens is the fine level of quality restorations and their own personal commitment to keeping their teeth clean with home-care and a concerned and conscientious hygienist.  Obviously, seeing a healthcare provider on a regular and continual basis can get you thru life smiling prettily.

I’d like to recommend the book “Younger Next Year” by Chris Crowley…check it out.

Please take care of yourself.   With care and attention, we all will be seeking a healthier way to live the next time we meet.

Thanks for your support,

Arnold F. Rothman, D.D.S., P.A.

 

Our staff is eager to help you achieve a healthy smile. “Let’s talk about your smile!” Please call our office at (305) 534-2002 to schedule an appointment or visit our website at http://www.4everteeth.com.

4everteeth Dental Center -Miami Beach

Dr. Arnold Rothman

http://www.4everteeth.com

(305) 534-2002

939 Arthur Godfrey Rd.

Miami Beach, Fl 33140

Thank you for trusting our office with your smile!

Miami dentist, Dr. Rothman, specializes on dental procedures such as dental implants, crowns and bridges, teeth whitening, bonding, veneers, fillings, dentures, and a complete spectrum of general and cosmetic dental services.

Dr. Rothman, is always available to answer any questions his patients have. His patients say that his staff treats them like family and that they feel comfortable in his office.

Our staff is eager to help you achieve a healthy smile. “Let’s talk about your smile!” Please call our office at (305) 534-2002 to schedule an appointment or visit our website at http://www.4everteeth.com.

4everteeth Dental Center -Miami Beach
Dr. Arnold Rothman
http://www.4everteeth.com
(305) 534-2002
939 Arthur Godfrey Rd.
Miami Beach, Fl 33140

Miami Beach Dentist, Dr. Arnold Rothman, Introduces iTero Digital Impression Technology and CAD/CAM System to Deliver Beautiful Smiles

 

Residents of Miami Beach, FL are now enjoying the benefits of future dental technology thanks to the efforts of a local Miami Beach cosmetic dentist, Dr. Arnold Rothman. iTero digital impression technology in conjunction with CAD/CAM (Computer Aided Design) systems are being used at the 4everteeth Dental Center to help patients achieve a healthy and beautiful smile. Amazingly, all this is achieved with fewer visits. “New technology such as digital impressions and precision implant planning has helped us take restorative dentistry to a new level. At the same time making it easier and more comfortable for our patients,” says Dr. Rothman.

Statistics show that 69% of adults ages 35 to 44 have lost at least one permemant tooth to an accident, gum disease, a failed root canal or tooth decay. These numbers go up significantly if you take into account broken, damaged, or discolored teeth. Luckily, patients can count on Dr. Rothman and his highly trained staff to use the best technologies available in dentistry today to restore their natural smile.

The first step in restoring teeth with dental implants, veneers, or dental crowns and bridges, is gaining accurate assessment of the patient's teeth and gums. Usually, this is followed by taking dental impressions and sending the models of the patient's teeth to a dental lab. This can extend the treatment by several weeks and multiple appointments. Dr. Rothman and his team have streamlined this process with the use of iTero, CAD/CAM technologies, and their state-of-the-art dental lab. Now, patients can have digital impressions done quickly and comfortably, and enjoy the benefits of precision made teeth-without the long wait.

“We know our patient’s time is valuable, and being able to minimize their treatment time is wonderful,” says Fatima Miranda, front desk coordinator at Dr. Rothman's office. This technology is a perfect complement to Dr. Rothman's advanced education in restorative and cosmetic dentistry. His extensive experience with dental implants, dental crowns, veneers, Invisalign (invisible braces), teeth whitening combined with top dental technology help him achieve striking results.
Dr. Rothman is proud to be one of the top restorative and cosmetic dentists in Miami Beach. His patients appreciate his compassionate personality and his drive to achieve dental excellence. All his staff members have been working with him for over fifteen years. They are knowledgeable, caring, and treat all their patients like family.

To learn more about the treatments offered at Dr. Arnold Rothman’s office please visit http://www.4everteeth.comhttp://www.4everteeth.com or call (305) 534-2002 to schedule an appointment. His office is located at 939 Arthur Godfrey Road, Miami Beach, FL 33140.

Dental Implants

Crowns and conventional bridges or dentures may not be your only options when replacing missing teeth. For some people, dental implants offer a smile that looks and feels very natural. Surgically placed below the gums over a series of appointments, implants fuse to the jawbone and serve as a base for individual replacement teeth, bridges or a denture.

Implants offer stability because they fuse to your bone. Integration of the implants into your jaw also helps your replacement teeth feel more natural and some people also find the secure fit more comfortable than conventional substitutes.

Candidates for dental implants need to have healthy gums and adequate bone to support the implant. A thorough evaluation by your dentist will help determine whether you are a good candidate for dental implants.

For more information visit www.ada.org

You can make an appointment with our dentist by calling our office at (305) 534-2002 or by visiting www.4everteeth.com.com. We are conveniently located in Miami Beach at 939 Arthur Godfrey Road, Miami Beach, FL 33140

http://www.4everteeth.com

Lets talk about your smile!

Tooth Decay and Your Water

For six decades, the American Dental Association has continuously endorsed the fluoridation of community water supplies and the use of fluoride-containing products as safe and effective measures for preventing tooth decay.The majority of bottled waters on the market do not contain optimal levels (0.7-1.2 ppm) of fluoride. And, some types of home water treatment systems can reduce the fluoride levels in water supplies potentially decreasing the decay-preventive effects of optimally fluoridated water. For more detailed explanations, visit www.ada.org.

For more information on dental implants, cosmetic dentistry, veners, Invisalign, or general dentistry please visit www.4everteeth.com or call (305) 534-2002.